Efficacy and safety of ultrasound‐guided radiofrequency ablation of hyperplastic parathyroid gland for secondary hyperparathyroidism associated with chronic kidney disease

Peng, Chengzhong; Zhang, Zhengxian; Liu, Ji‐Bin; Chen, Hongyu; Tu, Xiao; Hu, Rihong; Ni, Jun; Weng, Ning; Pang, Haisu; Xue, Zhengmei

doi:10.1002/hed.24657

Cited by 37 publications

(30 citation statements)

References 32 publications

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“…In the current study, two patients (one in single-session RFA and another in two-session RFA) developed hoarseness after ablation, and they both recovered within 70 days. As described in our previous study, a fluid spacing ablation method and moving-shot technique with 1-mm spare margin of the glands can avoid thermal injury of carotid artery, esophagus, trachea and other adjacent structures, especially for recurrent laryngeal nerves 30 . There were no other severe complications during RFA or within the follow-up period in this study.…”

Section: Discussionmentioning

confidence: 90%

“…High PTH has greater effects on osteoclast than osteogenesis 20,45 . Thus, patients with SHPT have high serum PTH and high metabolism of bone transport 30 . With complete ablation of hyperplastic parathyroids, serum PTH can decrease rapidly alone with osteoclast activity decreased or disappeared in a short time, and then osteoblastic activity continues.…”

Section: Discussionmentioning

confidence: 99%

“…We have used RFA to treat parathyroid hyperplasia in patients with SHPT and to reduce serum PTH, calcium, and phosphorus levels. Complications from RFA, such as nerve injury, hemorrhage, infection, trauma and fever, are fewer and recovery is shorter compared with surgery 30 .…”

mentioning

confidence: 99%

“…Our previous studies demonstrated that ultrasound (US)-guided RFA of parathyroid hyperplasia is effective for treating SHPT 30 . However, the severe hypocalcemia has been critical issues after thermal ablation, which may be related to the timing and sessions of the treatment.…”

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confidence: 99%

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Efficacy of Ultrasound-guided Radiofrequency Ablation of Parathyroid Hyperplasia: Single Session vs. Two-Session for Effect on Hypocalcemia

Zeng

Peng

Liu

et al. 2020

Sci Rep

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To evaluate safety and efficacy of one-vs. two-session radiofrequency ablation (RFA) of parathyroid hyperplasia for patients with secondary hyperparathyroidism (SHPT) and to compare the outcome of both methods on hypocalcemia. Patients with secondary hyperparathyroidism underwent ultrasound guided RFA of parathyroid hyperplasia. Patients were alternately assigned to either group 1 (n = 28) with RFA of all 4 glands in one session or group 2 (n = 28) with RFA of 2 glands in a first session and other 2 glands in a second session. Serum parathyroid hormone (PTH), calcium, phosphorus and alkaline phosphatase (ALP) values were measured at a series of time points after RFA. RFA parameters, including operation duration and ablation time and hospitalization length and cost, were compared between the two groups. Mean PTH decreased in group 1 from 1865.18 ± 828.93 pg/ ml to 145.72 ± 119.27 pg/ml at 1 day after RFA and in group 2 from 2256.64 ± 1021.72 pg/ml to 1388.13 ± 890.15 pg/ml at 1 day after first RFA and to 137.26 ± 107.12 pg/ml at 1 day after second RFA. Group 1's calcium level decreased to 1.79 ± 0.31 mmol/L at day 1 after RFA and group 2 decreased to 1.89 ± 0.26 mmol/L at day 1 after second session RFA (P < 0.05). Multivariate analysis showed that hypocalcemia was related to serum ALP. Patients with ALP ≥ 566 U/L had lower calcium compared to patients with ALP < 566 U/L up to a month after RFA (P < 0.05). Group 1's RFA time and hospitalization were shorter and had lower cost compared with Group 2. US-guided RFA of parathyroid hyperplasia is a safe and effective method for treating secondary hyperparathyroidism. Single-session RFA was more cost-effective and resulted in a shorter hospital stay compared to two sessions. However, patients with two-session RFA had less hypocalcemia, especially those with high ALP.Secondary hyperparathyroidism (SHPT) commonly occurs in patients with end stage renal disease (ESRD) when low calcium levels and high phosphorus levels over time stimulate increased PTH secretion 1-3 . SHPT increases the risk for osteoporosis and kidney stones, as well as for parathyroid hyperplasia, a condition that can cause mental abnormalities, renal osteodystrophy, calcific uremic arteriolopathy, vascular calcification, muscle spasms and even lead to respiratory or cardiac arrest 4 .Treatment for SHPT includes vitamin D sterols, intravenous vitamin D analogs and cinacalcet 5-10 to improve biochemical profiles and other surrogate markers 11 . Patients with severe SHPT may be candidates for parathyroidectomy (PTX), which increases long-term survival and reduces the risk of fracture in ESRD patients 12 . However, hyperparathyroidism recurs in up to 30% of patients treated with PTX due to incomplete excision of all hyperplasic parathyroid glands 13,14 . Meanwhile, PTX can potentially result in permanent hypoparathyroidism if the parathyroid glands are over-excised 15 .

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Efficacy of Ultrasound-guided Radiofrequency Ablation of Parathyroid Hyperplasia: Single Session vs. Two-Session for Effect on Hypocalcemia

Zeng

Peng

Liu

et al. 2020

Sci Rep

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“…Among the treatments for parathyroid hyperplastic glands in chronic renal failure patients with HPT, RFA, LA and ethanol ablation could achieve similar clinical efficiency compared with that of MWA [18,25,35,[38][39][40]. Although the prominent advantage of MWA is the higher thermal efficiency which could achieve larger ablation with less time used, it is with less manipulative for smaller lesions compared with that of RFA and LA.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of microwave ablation for ectopic secondary hyperparathyroidism: a feasibility study

Wei

Shao

et al. 2019

International Journal of Hyperthermia

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2019)Efficacy and safety of microwave ablation for ectopic secondary hyperparathyroidism: a feasibility studyABSTRACT Objective: To assess the feasibility of microwave ablation (MWA) in treating ectopic secondary hyperparathyroidism (SHPT) in patients with chronic renal failure. Methods: In this retrospective study, MWA was used to manage 22 SHPT nodules in 20 patients. The laboratory test results, including intact parathyroid hormone (iPTH), serum calcium, phosphorus and alkaline phosphatase (ALP) levels; clinical symptoms; complications before, at one day after MWA, and at the end of follow-up were recorded and compared. Both echogenicity and size of SHPT nodules on ultrasound were documented before and after MWA. Results: iPTH levels decreased from 1106 ± 396 pg/mL to 264 ± 251 pg/mL (p < .001). Serum calcium and phosphorus levels decreased from 2.53 ± 0.21 mmol/L to 2.14 ± 0.25 mmol/L (p < .001) and from 1.96 ± 0.52 mmol/L to 1.76 ± 0.49 mmol/L (p < .05), respectively. There was no significant change in ALP levels across the different measurements (p ¼ .895). No significant differences were detected in iPTH, serum calcium and phosphorus levels, which were all in the normal range during the follow-up period (3-26 months, mean: 15.49 months) after MWA (p ¼ .186). The echogenicity of SHPT nodules changed from hypoechogenicity to uneven hyperechogenicity with a volume decrease in the majority of the nodules. Mild symptoms of Horner's syndrome occurred in one patient (5%), which improved during the follow-up period. A hematoma was encountered during ablation (5%). Hypocalcemia occurred in four patients one day after MWA (20%). No other complications were associated with MWA. Conclusion: MWA is a feasible option to treat ectopic SHPT nodules for destroying parathyroid gland tissue in ectopic SHPT with long-lasting clinical effects. ARTICLE HISTORY

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Parathyroid Diseases Laser Ablation

Solbiati

Zhan

Mauri

2019

Image-Guided Laser Ablation

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Efficacy and safety of ultrasound‐guided radiofrequency ablation of hyperplastic parathyroid gland for secondary hyperparathyroidism associated with chronic kidney disease

Abstract: RFA of hyperplastic parathyroid glands for treating secondary HPT is feasible in selected patients. © 2016 Wiley Periodicals, Inc. Head Neck 39: 564-571, 2017.

Cited by 37 publications

References 32 publications

Efficacy of Ultrasound-guided Radiofrequency Ablation of Parathyroid Hyperplasia: Single Session vs. Two-Session for Effect on Hypocalcemia

Efficacy of Ultrasound-guided Radiofrequency Ablation of Parathyroid Hyperplasia: Single Session vs. Two-Session for Effect on Hypocalcemia

Efficacy and safety of microwave ablation for ectopic secondary hyperparathyroidism: a feasibility study

Parathyroid Diseases Laser Ablation

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